Scope It Out

By Ralph Stephens, BS, LMT, NCTMB

Ignorance is only bliss until reality smacks you in the face. As promised last time, the discussion of regulation (licensure) continues. This month's subject is scope of practice, an area in which we really are punishing ourselves and decreasing our ability to help the public, due to the poorly written laws we are passing.

Another purpose of licensure is to define the scope of practice of a particular profession.

To use more accurate terms, scope of practice defines the extent of the monopoly granted by the state. Of course, the MDs who were first to the trough have a virtually unlimited scope of practice. That was their goal in creating licensure: a complete monopoly, along with the elimination or complete control of all competing forms of health care. It still is their goal, and universal access to health care may give it to them if we are not diligent. Every other profession has their scope limited by their licensing law.

Most professions desire as much extension of a scope of practice as they can get and always are working to expand it. Sadly, ours is not this way nationally. Our national leadership has given up huge aspects of our scope for no apparent reason, other than to just pass something. For example, any muscle-bound meathead at a health club can do specific stretches on anyone who walks in the door, but we pass laws for ourselves that prohibit us from doing specific stretches or joint mobilization. This has got to stop and should be reversed.

Our profession has failed miserably when it comes to defending our scope. I have watched it shrink to a shadow of what we should be able to do. In most licensed states, we no longer can do what massage therapists of the 1950s and 1960s did very well - without licensure. Our national leadership's willingness to restrict our scope of practice actually is endangering the public and limiting the care the public can receive. If alternative disciplines give up scope of practice, where can the public receive it? The public frantically is searching for alternatives to the current health care system, which is the single biggest killer of Americans. That's right. According to their own figures, allopaths kill more than 250,000 people each year; yet allopaths call alternative practitioners "quacks." By passing laws that end our ability to perform what historically has been the scope of massage therapy, we are forcing the public back into the hands of the allopaths - to face cuts, burns, poisons and even death. "Sorry, we used to be able to treat the soft-tissue conditions of scoliosis, but our new law won't allow us to manipulate the spine. So, I guess you will have to go get rods installed." How does it feel, Indiana?

By not having a logical, aggressive plan to pass uniform legislation for massage in every state to protect and expand our scope, our national leadership is depriving the public of the soft-tissue care it seeks, needs and deserves. In the process, our leadership slowly is killing the therapeutic side of our profession. It's the first-door-provider, therapeutic massage practice that the public needs and that allows massage therapists to make a comfortable income. Every massage licensing law should give us first-door access to the public, along with the right to assess, examine, manipulate and otherwise treat connective tissue with whatever means, techniques and equipment we are trained in. Training should be able to come from school or post-school sources. Stretching, movement and alignment techniques are necessary for proper and complete soft-tissue care, and should be included in our scope. While we might have to do it subtly, language-wise, this is the outcome we should achieve. Anything less is merely a self-imposed tax on our practice with no resulting benefit, except maybe to our egos - "I'm licensed."

If the massage profession is going to impose licensing, it should benefit from it, not suffer from it. Remember, the purpose of licensure is to benefit the profession and to protect it from the public and other professions. Don't say that when you are trying to pass a bill, but it is the reality of the situation and needs to be kept in mind. Every professional benefits from good legislation and suffers from poorly written laws.

At one time, I was a huge proponent of licensure. However, in the past few years I have been on the opposing side of several laws, because the laws were so poorly written that, had they passed, they would have been more of a burden than a benefit. Be alert as to what is being proposed in your state. Don't let a law restrict what you can do more than if you didn't have the law. Wakeup out there! A bad law is worse than no law.

Speaking of bad laws, Indiana is in the process of passing one. It will be another patch in the quilt of completely incompatible laws we have imposed on ourselves. It will be nothing but a burden on practicing therapists, but the schools are going to love it. Allowing schools to do whatever they want is all that is important, right? Indiana therapists, if there still is time when you read this, I encourage you to fight the legislation. If it's already passed, read this and weep.

So, what is the point of all this licensing discussion, other than just the educational aspect of it? Well, colleagues, it's about paradigms and what our profession once was, could be, but instead is becoming. Not enough ink to write on that until next time.

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